Pam T.

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There's an article published in the American Journal of Health-System Pharmacy about how medications and nutrients are malabsorbed after weight loss surgery - gastric bypass specifically. I found this article while doing some research on how calcium is absorbed in a patient with no stomach acid. But this article contains so much great information about our new digestive system that I think every WLS patient should read it. I also think every doctor needs to read this article as well. I'll be taking a copy of it to my PCP at my next appointment in a few weeks.

Medication and Nutrient Administration Considerations after Gastric Bypass
Click the link near the top of the page that says "manual download" and the PDF version will appear.

So go read it. Print it. Keep it as a reference. Share it with others and share it with your doc.

~Pam

Here are a few of my favorite protein shake recipes.  Even though I have a few other flavors and brands of protein powder -- I've pretty much settled down to the Body Fortress Chocolate and Vanilla as my favorites.  Strange that they are my favs now --- before surgery this is what I used, but right after surgery I hated their taste.  Now I'm back to loving them again.  It's fine by me since they are cheap and easy to buy at Wal-Mart.

PROTEIN CHOCOLATE MILK
1 scoop chocolate protein powder
8 oz milk
(tastes just like Nestle Quik chocolate milk!)

PROTEIN HOT COCOA
1 scoop chocolate protein powder
8 oz hot water
splash sugar-free coffee creamer (french vanilla is my current fav)
Whiz in blender until smooth -- great hot cocoa!

PROTEIN FRUIT SMOOTHIE
1 scoop vanilla protein powder
1/2 c. frozen peaches or strawberries or whaever fruit you want
1 c. orange flavored crystal lite (or sugar free tang)
1 big tablespoon yogurt
Whiz in blender until smooth.  If you use fresh fruit, add ice cubes.  Great smoothie!

PROTEIN HOT CHAI TEA
1 scoop vanilla protein powder
1/2 c. sugar free chai tea mix (heated in microwave)
1/2 c. hot water
splash of sugar free coffee creamer
Whiz in blender slightly.  Makes a great hot chai tea! (You can also do this cold if you like.)

PROTEIN MOCHA LATTE
1 scoop chocolate protein powder
1 teaspoon decaf instant coffee
8oz hot water
splash of sugar free coffee creamer
Whiz in blender slightly.  Tastes like a mocha java latte!

I feel like I post this so often on the forums, so I thought I'd put it here in my profile too.

It's VERY important that after RNY that we take calcium citrate. This form of calcium is the most soluble in a non-acid environment.  After surgery there is no longer any gastric acid in our pouches - or very little, and what is there is often suppressed with acid blockers for the first year after surgery.  (I'm taking Prevacid per my surgeon's orders.)   The cheaper and more readily available form of calcium - which is carbonate - requires gastric acid to be broken down within the stomach and absorbed by the intestines. 

There's a medical condition called Achlorhydria - which is when a patient has no stomach acid (hydrocloric acid).  By studying this condition we can learn a lot about how we as post-RNY patients should be treated by our doctors and which medications and supplements we need to choose. 

In a study published in the New England Journal of Medicine by R.R. Rekker the calcium absorption rate of achlorhydria patients was studied.  After giving test subject a dose of calcium, the bioavailability (absorption of the dose) was measured.  His finding were:

Calcium Carbonate Absorption = 4%
Calcium Citrate Absorption = 45%

So it's clear that after gastric bypass surgery we MUST take calcium citrate in order to have a chance at having healthy bones and teeth. 

So here's what I take:

UpCal-D ---- this is a powdered calcium citrate with Vitamin D3.  In each tiny scoop I get a dose of 500mg of calcium citrate and 250IU of Vitamin D3.  I mix it with my protein shake, plain water, food or whatever - it's tasteless and dissolves very easily with anything.  I've even started to just pour the dose on my tongue and take a swallow of water - kind of like a Pixie Stix.  It has a slightly sweet taste, not yucky or medicine-y at all.

The best prices I've been able to find are from Colonial Medical.  You can either order directly from their website or from their Amazon storefront.  The 16oz jar w/ 227 servings is $10.95.  The 120-pack box of individually packaged serving sizes is $11.95.  I keep the jar at home to use and keep several individual packets in my purse for when I'm on the go.  Here are the links to their websites:

Amazon -- 16oz Jar
Amazon -- 120-pack Box
Colonial Medical -- 16oz Jar
Colonial Medical -- 120-pack Box

Amazon only ships to US addresses.  But Colonial Medical will ship internationally if you order from their website.

Citrical Creamy Chews ---- These are tiny - 2 bite - chunks of calcium that taste like candy.  They come in lemon, caramel or fudge.  My favorite is the fudge because it gives me my chocolate fix for the day.  Each chew is 500mg of calcium citrate and 250IU of Vitamin D3. They are pretty pricey (about $8 for a box of 30), but because it keeps my sweet tooth at bay, I can justify the cost since I only take 1 or 2 per day.  I make up the rest of my doses of calcium with the UpCal-D.

Unfortunately, these have been discontinued by the manufacturer. So if yo find a box you're lucky.  The Citracal brand was sold to another company and during that sale the Creamy Chews were not picked up.  However, my understanding is that the Creamy Chews "recipe" (or whatever it's called) is still owned by the original company and there is some rumor that they will be put back into production under a different name.  We'll see.

My surgeon's office recommends I take 1200mg of calcium per day.  Which seems like a silly number since the body can't absorb more than 500mg per dose, so you'd would need to take 3 doses anyway, so why not just say 1500mg?  But that's a whole other story....

So, back to my surgeon's recommendation of 1200mg...... because I'm on birth control, my GYN has recommended that I increase my calcium intake above the normal range because Depo Provera tends to leach calcium from the body.  So I take 2000mg per day. 

Here's my calcium schedule:

Pre-Breakfast Protein Shake --- 500mg
After Lunch -- 500mg
After 4:30 Snack -- 500mg
After Dinner -- 500mg

It's best to take calcium with food because it will absorb better.  However, if your meal is very high in iron (green leafy veggies or beef) then you might want to avoid a dose of calcium after that meal and find a different time to take it.  Iron interferes with the absorption of calcium.  That's why I take my multi-vitamins at different times than I take my calcium because my vitamins have iron in them.

If you have any questions about calcium, feel free to ask.  I'll do what I can to shed some light.

Pam

Wow!  It's been nearly a month since I've posted anything here.  Sorry for the lapse.  I've been updating my other blog more often, so you're welcome to check that out if you'd like.

Journey to a Healthier Me

So, let me update you on what's going on with me lately...

EATING IS GETTING EASIER
A month and a half ago eating was my daily nightmare.  My poor pouch just didn't want to deal with any type of solid food and just rejected everything.  I would switch back to liquids almost every 1 or 2 days then try solid food again.  Eventually I determined that it wasn't so much the food that I was eating, but HOW I was eating.  When they say "chew, chew, chew" they really mean it.  I had to learn how to eat all over again and that involves chewing every single bite 25 times before I even think about swallowing. 

BUT -- things are easier now that I've learned how to chew and take my time with eating.  I can deal with almost everything I try eating with only a few exceptions (chicken, specifically).  Here's what a typical days eating looks like for me:

Pre-breakfast ---- Protein Hot Cocoa
Breakfast --- Carb Master Yogurt (Kroger brand) has 12g protein!
Lunch --- usually salad and soup or chili
Snack --- cheesestick or dry roasted edamame or protein bar
Dinner --- some type of meal and some veggies or salad

Sticking to a schedule has really helped me stay on track with my eating.  For meals/snacks that I often forget (like breakfast and afternoon snack) I have an alarm set on my cell phone to remind me.  I also have alarms set for water too during times of the day when I often forget to drink water (like right after lunch and after dinner). 

KNOW WHAT YOU'RE EATING
I keep track of all the food that I eat on www.FitDay.com.  I'm at the computer most of the day at work and even at home, so this is the easiest method for me.  Some people prefer a written journal instead.  Even though I'm not necessarily overly concerned about calories, keeping track of my food helps me meet my daily protein goals.  I can see immediately if I'm going to run low by the end of the day.   I can also see if I need to add a bedtime snack of a protein snack since I'm keeping track of things all throughout the day.  It really helps to keep me accountable.

IT'S NOT ALL ABOUT THE FOOD - WORK ON YOUR HEAD TOO!
They do surgery on our stomach, not on our mind.  So we really need to work hard to re-train the way we think about food and re-examine our relationship with food. 

So I'm going through a 10-week group therapy session with the psychologist office at the bariatric center.  We are establishing a Comprehensive Holistic Wellness Plan.  We are examining ALL areas of our life and setting goals for each area.... things like relationships, spirituality, finances, vocation, education, health & exercise and several other things.  We're also working on ways to effectively deal with stress, mental distractions and those crazy cravings and hunger feelings. 

I highly recommend working with a psychologist early out from surgery to help you deal with all the mental and emotional issues we, as morbidly obese people, have tried to heal by using food.  Now that we no longer have food to heal our mental problems, we need to figure out how to deal with them in more healthful ways.

So that's the latest news on me.  I'll try to do a better job at keeping this blog updated as often as my other blog.  If I start to slack, just holler at me and get me back on track.  :-)

~Pam

I just responded to a post about how to get on an eating schedule.  I've found that I must be one of the lucky ones because my nutritionist hands out an hour-by-hour eating and drinking schedule for newbies to follow.  I used it religiously at the beginning, but I've also based my current eating habits on this original schedule. 

So to save myself from having to type it out again.. I'm going to copy the schedule here.  (Yep, I'm lazy!)  LOL!

8:00 8:30 - Breakfast (meals take no more than 30 minutes to eat)
9:00 - 10:00 - Water - 8oz.
10:00 - 11:00 - Snack (protein shake)
11:30 - 12:30 - Water - 8oz
1:00 - 1:30 -- Lunch
2:00 - 2:30 - Water oz.
3:00 - 4:00 - Snack (protein shake)
4:30 - 5:30 - Water - 8oz
6:00 - 6:30 - Dinner
7:00 - 8:00 - Water - 8oz
8:30 - 9:00 - Snack (protein shake)
9:30 - 10:30 - Water 8oz.

I concocted a new recipe this morning for my daily protein drink. It's pretty delicious!

Hot Chai Protein Tea
(I have a 12oz mug, so if your's is smaller, adjust accordingly)

1 scoop Nectar Vanilla Bean Torte Protein Powder
4 oz. Oregon Sugar Free Chai Tea mix
7 oz. Soy Milk (I use the kind with added fiber)

While milk is warming in pan on stove, mix together Chai mix and protein powder in mug. Stir like crazy to get out all the lumps. I actually put it in the blender cuz I was lazy this morning. Add the hot milk and mix again.

Yum!

Over the past couple weeks I've gotten into a routine with a couple different recipes.  They have become my comfort foods.  I thought I'd share the recipes.

 
VANILLA EGG CUSTARD
(I found this recipe on BariatricEating.com and it's a recipe from Susan Marie.)
4 eggs, beaten (or EggBeater equalivalant)
pinch of salt
1 c. milk
1 can evaporated milk
2 t. vanilla
1/2 c. Splenda Granular
nutmeg

Whisk all together very well. Pour through a sieve into 6 (4oz) custard cups sitting in a 9x13 pan. (I skip the sieve part.)  Pour hot water to a 1-inch depth in large pan. Bake in a 325 oven for 25-27 minutes. (Just until set, centers will still be jiggly). Remove to wire rack to cool.


PROTEIN HOT COCOA 
This is a recipe I have heard several people here on OH talk about and once I tried it, I was hooked.  I've made a few changes from the basic recipe and change the flavor with different creamer or syrup flavors. 

** Put a teapot of water on to heat.
** Add 1 scoop of chocolate protein powder to your mug.
** Add to the powder 2 or 3 tablespoons of Sugar Free International Delight Creamer French Vanilla (find it in the dairy section)
** Add a splash of Divinci syrup (usually French Vanilla)
** Stir like crazy until you have a smooth paste with no lumps
** Add  your hot water to the protein & creamer mixture and use a whisk to mix it well.

This comes out frothy and delicious and tastes just like my normal homemade hot cocoa.  It's very soothing as a snack just before bed.

I found this file online somewhere (don't remember where) that shows how a NORMAL digestive system works at absorbing the nutrients we eat.

1. Stomach --- digestion gets a jumpstart here to prepare it for the intestine
2. Duodenum --- this part of the small intestine is 1 foot long
3. Jejunum - this part of the small intestine is 8 feet long

Draw an imaginary line halfway through the Jejunum and everything between the stomach and that line is no longer being used. It's gone, the functions of those body parts no longer work. 

And that, folks, is why we take supplements!

I see a TON of questions from new post-ops or soon-to-be-post-ops about protein.  What kind tastes best, where to buy it, what to get, etc.  I also see a lot of people answer those questions with a reply of what *their* favorite flavor or brand is. 

We all know that what tastes great to one person can taste horrible to the next.  So I really never understood why people just list their favorite and think that's good enough. 

I would suggest PROTEIN SAMPLES for anyone searching for a protein they can love.

 After surgery your tastes will change a bit so something you like now might not work for you after.  And since protein powder is so expensive, samples is the best way to try out a whole bunch of different kinds without breaking the bank.

www.enjoyhealth.com -- I ordered their 21-flavor pack which gave me a chance to try out the Nectar and Champion flavors.  I found a couple that I loved.

www.bariatriceating.com -- They also have samples at reasonable prices.  I ordered about a dozen different flavors from their ale-carte selection. 

www.vitalady.com -- I haven't ordered from her, but I hear that many have had great success with her samples as well.

GNC -- They have a few varieties for sale but also often have samples under the counter that they give away.  I was in my local GNC the other day and mentioned I was having problems finding a vanilla brand that I loved and the sales clerk gave me 5 packages of 2 different brands of powder to try.  For free.

Also, if you're a part of a support group locally, ask the members to all bring you a scoop of their favorite in a ziploc baggie.  This will let you try a variety without cost and they are always more than happy to help a fellow newbie out!

I am 4 weeks out and finally found 1 powder that I LOVE (Champion Cookies -n- Cream) so I've only bought 1 jar of powder (best price at www.allstarthealth.com).  Otherwise I've been living on samples.

Nearly all Whey Protein Powders are very low in carbs.   For instance, Champion has 24g protein, 3g carbs (1.5g of sugar), 130 calories.  When shopping for something be sure to always check the sugar content and also look for "Whey Isolate".

HTH
~Pam

Josully left a comment on my blog and asked what my typical daily menu was like.  Great question!  I'm about 3.5 weeks out from surgery and just started a new section of my eating plan -- I got to add tuna, canned chicken and canned salmon this week.  So far I have not had any problems at all with food - so thankful! 

Here's what I'm eating now:

9:00 am - Breakfast
Usually a veggie fritatta or egg salad.  The Frittata is easy to make and I found the recipe in the WLS cookbook I  mentioned in last week's post.  I chopped up a bunch of veggies (small summer squash, small zucchini, tiny head of broccoli, white button mushrooms chopping small).  Once all those are chopped up  it make about 3 or 4 cups of chopped veggies - I've used a tiny handful in a bunch of different things all week.  So the Frittata.  Add about 1/8c to 1/4c of mixed veggies to a small frypan and sautee with a spray of butter flavored Pam cooking spray until they are soft.  In the meantime, mix 1 egg with a bit of water or milk.  When the veggies are soft, add the egg to the pan and swirl until everything is covered.  Add salt, pepper and dill weed to taste.  Cover and let it cook on medium heat.  When it's just about done, add a sprinkling of cheese (cheddar or whatever).  Then stick the whole pan under the broiler for a minute or two until the cheese is hot and bubbling.  Yum!   this is about 10 grams of protein.

11:30 or so - Snack
8 ounces of protein shake.  I make mine with soy milk.  My Nut suggested using soy milk  because its so common for people to be lactose intolerant after surgery.  I might not be, but I'm to chicken to test it just yet.  I'm using Champion Cookies -n- Cream flavor right now although I have several more sample flavors to try too.  This has 24g of protein.

1:00 or so - Lunch
3 to 4 onces of tuna salad.  I make it with pouch tuna, diced dill pickles and mayo.  Sometimes I add 2 or 3 whole wheat crackers, sometimes I add an extra dill pickle on the side.  Yum! This has about 26g of protein.

3:30 or so - Snack
8 ounces of protein shake.  If ever there's an eating step that I skip it's usually this one.  Or instead of a shake, I might just have something else small like a yogurt or pudding or jello. 

6:30 or so - Dinner
Lately I've been doing more tuna for dinner.  But I just went grocery shopping last night, so I will probably try some chicken salad tonight.  Tuna is another 26g of protein.  Last night I was out and about shopping, so I stopped at Wendy's for some chili  - half of a small is about 10g of protein.

9:00 or so - Snack
I'm suppose to have another shake at this point.  If I skipped it at 3:30, then I'll have one now, but if I had one at 3:30, I'll skip this one. 

At the end of the day I normally reach my goal of 75g of protein.  I'd like to get up to 100g per day but will have to work on that a bit more.

I've also been thinking about what I'll be eating when I got back to work.  Gonna need to figure out a schedule for that major change.  I'll be starting my day at 6:30 and won't be home until 7:00 for dinner.  I've got 10 days left to my time off, I'm going to enjoy every minute of it too!

Enough rambling for today...
Pam